Caldwell-Luc operation

or maxillary antrostomy
1. Identification and description of the procedure

You are suffering from a disease in one or both sinuses or cavities found in both sides of the nose and
housed in the interior of the maxillary bone.

This operations is performed under general anaesthesia and consists in opening the sinus through an
incision in the bucal cavity over the superior teeth, hence visible scars will be left.

2. Purpose of the procedure and benefits that are expected to be achieved

It is performed to diagnose, evaluate and/or treat a disease located in the maxillary sinus.
The benefits that this procedure will provide you with is an improvement in the symptoms, in case of a
successful intervention and obtaining a certain diagnosis.

3. Reasonable alternatives to this procedure

Some of the diseases in which this operation is recommended can be treated with medication. The operation
is posed in the case of failure or no possibility of treatment.

4. Foreseeable consequences of its performance

After the intervention you will have the nose plugged up for at least one day. In some occasions, plastics
are placed that must be left for a longer time, it is normal to notice some discomforts such as nasal dryness
or scabs.

5. Foreseeable consequences of its non performance

If the operation has been recommended to obtain a diagnosis, you will not have the possibility of obtaining
an adequate treatment. Continue with the symptoms from which are suffering now, with the possibility
complications with the ocular, dental and the soft parts of the face.

6. Risks

Possible risks are:

Pain in the cheek: the first days after surgery.

Haemorrhage: that could require blood transfusion.
Infection of the wound.
SPECIALITY IN OTORHINOLARYNGOLOGY

Lesion of the infraorbitally nerve with loss of sensitivity in the superior teeth.
Eye lesion.
Failure of the operation wound healing over the superior teeth.
Relapse of the illness.

Side effects:

Decrease in the sensitivity of the cheek and the superior teeth that disappears after a few weeks.
Oroantral fistula: orifice that communicates the bucal cavity (mouth) with the maxillary sinus.
Ocular lesion: even though it is very rare, alterations in the ocular mobility or decrease in the sharpness
can be an after-effect.
Non-resolution of the illness.

The vital risks are not very frequent, even though, as in any medical act and keeping in mind the necessity
of general anaesthesia in all the cases, they can occur.

7. Risks depending on the patient's clinical situation

Other risks or complications that might appear, given your clinical situation and your personal circumstances,
are ............................................................................................................................................................................................................
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 Caldwell-Luc operation
or maxillary antrostomy

Declaration of consent

Mr./Mrs./Miss. aged , with home address at

, National Identity No. and SIP number

Mr./Mrs./Miss. aged , with home address at

acting in the capacity of (the patient's legal representative, relative or close
friend) , with National Identity No.

Hereby declare:

That the Doctor has explained to me that it is advisable/necessary in my

situation to perform a

and that I have adequately understood the information he/she has given me.

In on ,2

Signed: Mr./Mrs./Miss. With National Identity Card No

Signed: Dr. With National Identity Card No

Associate number

Revocation of the consent

I hereby revoke the consent granted on the date of ,2 and I do not wish
to carry on with the treatment that I hereby terminate on this date.

In on ,2 SPECIALITY IN OTORHINOLARYNGOLOGY

Signed: The Doctor Signed: The patient

Associate number: